Jamie Foster of Hempsons argues that the NHS needs to change to meet the significant challenges it faces following the Conservative win at the General Election
The Conservative Party manifesto 2015 pledged to ‘protect and improve’ the NHS. So what is this likely to mean for the NHS over the next five years? In this article, Jamie Foster of Hempsons, considers the implications of the Conservative Party’s election victory
The headline news – and the subject of David Cameron’s first major post-election speech – is the commitment to transform the NHS into a seven-days-a-week service.
Equally significant is the commitment to implement the NHS Five Year Forward View (FYFV), the long-term plan for how the NHS needs to change to meet the challenges it faces. The FYFV and the Conservative Party manifesto identify a number of ways in which the NHS can seek to meet these challenges. These include:
In addition, the FYFV set out plans to redesign health and care systems to improve quality of care, reduce health inequalities, and address productivity and efficiency challenges. To make this happen it proposes stimulating the creation of a number of major new care models.
NHS England’s commissioning intentions indicate a continuing desire to develop consolidated centres of excellence for specialised services where quality and patient volumes are strongly related, but not at the expense of the local acute hospital model
The FYFV suggests that while the answer is not one-size-fits-all, nor is it simply to let ‘a thousand flowers bloom’. It proposes that the NHS should test a number of models and in response to this NHS England has set up a programme to accelerate the design and implementation of new care models. Twenty-nine ‘vanguard’ geographies have been chosen that will take the national lead on transforming care for patients in towns, cities and counties across England.
This complements work in other areas intent on transforming care, including in Greater Manchester. A memorandum of understanding has been signed by all Greater Manchester local authorities, CCGs and NHS England to develop a framework for the devolution of health and social care responsibilities. The Government is keen to extend this devolution model to other cities.
All of these developments aim to support improvement and integration of services by breaking down traditional divides between primary care, community services, secondary care and social care, and by delivering increasingly-personalised and integrated care for patients. The assumption is that if organisations work together then better outcomes may be achieved. New care models will involve all types of commissioners and providers of NHS-funded and local-government funded services.
So what are these new care models? Broadly, they can be summarised as follows:
There is consensus that the NHS needs to change to meet the significant challenges it faces – but there is opposition to making some of the changes which the Government believes are necessary
The Government wants to transform access to the NHS by ensuring everyone will be able to see a GP and receive high-quality hospital care seven days a week. This is, of course, admirable, but does give rise to a concern about how it will be funded. The funding gap identified by the FYFV assumes that services continue to be provided in their current form rather than being extended to seven days a week. So will new funding be made available for this, or will reconfiguration and consolidation of existing services be required to free up money for seven-day working?
There are also potentially-significant workforce implications associated with providing seven-day services. Existing inhibitors to the change in hospitals include consultants’ right to refuse non-emergency work (between 7pm-7am and weekends), restrictions on junior doctors’ working hours, and the enhanced payments for unsocial hours under the Agenda for Change. The negotiations between NHS Employers and the BMA are likely to start again soon after they broke down at the end of last year. This may lead to the removal of some of the inhibitors, but there will be other challenges associated with a likely increase in shared service provision. Where organisations collaborate to provide services, these will include TUPE transfers and secondments and a need to increase the skill mix across the NHS workforce.
There is consensus that the NHS needs to change to meet the significant challenges it faces – but there is opposition to making some of the changes which the Government believes are necessary. Both the FYFV and the Government’s plans to implement it are ambitious, making it likely that the next five years will be both interesting and challenging.